Equity-League Health Trust Fund Summary Plan Description (SPD) Modifications

Since April 1, 2005, the Equity-League Health Trust Fund has made some changes to the rules and benefits available to participants eligible for health coverage. The text that follows provides you with a summary of changes that have been made and are currently in effect. Each item is referenced to the page number that the benefit is currently listed under. All of the other contents within the SPD remain current, and are available to you under the Health Fund.

If you have any questions, please feel free to contact the Health Department within the Fund Office, and a representative will assist you. Our walk-in office hours are Monday through Friday, 9:30 AM to 5:30 PM Eastern Time. Telephonic office hours are 9:30 AM to 7:00 PM Eastern Time.

Introduction Section

Certain Board of Trustee members have changed as well as the Plan’s personnel/professional Fund Office staff. For an up to date list, please contact the Fund Office. One major change is that Art Drechsler, the Fund’s Executive Director, has replaced Stephen Roderick as the Equity-League Fund Manager.

Contacting the Fund Office

There is now one Fund office location, in New York:

165 W 46th St 14th Floor

New York, NY 10036-2582

Phone - (212) 869-9380 or outside NY toll free (800) 344-5220

Fax – (212) 869-3323

health@equityleague.org
www.equityleague.org

Equity-League no longer has offices in the cities of Chicago and Los Angeles. All of the Fund Offices’ operations have been consolidated to our New York Office.

Page 1 - Highlights of Your Equity-League Health Trust Fund Benefits:

Prescription Drug Benefits with CIGNA:

The Annual Deductible of $100.00 per person/$200.00 per family applies to prescriptions filled at a pharmacy as well as through TEL-DRUG, CIGNA’S mail order pharmacy program. This also applies to the information regarding pharmacy benefits on pages 34 and 35 of the SPD.

The following chart applies to the current co-payments participants are responsible for when filling prescriptions under the CIGNA Pharmacy Plan. The change in pharmacy benefits also modifies the description of this benefit on pages 34 and 35 of the SPD.

	CIGNA Participating Pharmacies	CIGNA Non-Participating Pharmacies	Through the TEL-DRUG Mail Order Program
Maximum Supply	30 days	30 days	90 days
Your Cost
Generic*	Greater of $10 Copay or 20% of actual cost.	30% of actual cost.	Greater of $20 Copay or 20% of actual cost.
Preferred Brand-Name	Greater of $20 Copay or 25% of actual cost.	30% of actual cost.	Greater of $40 Copay or 25% of actual cost.
Non-Preferred Brand-Name	Greater of $25 Copay or 30% of actual cost.	30% of actual cost.	Greater of $50 Copay or 30% of actual cost.

As of January 1, 2009, the most any participant will be required to pay in regular prescription drug deductibles and copays combined will be $5,000 annually. Once you hit the cap, the Fund will pay:

• Generic drugs: 100% of eligible prescription drug expenses for the rest of a calendar year.

• Preferred Brand-Name drugs: 100% of eligible prescription drug expenses for the rest of a calendar year.

• Non-Preferred Brand-Name drugs: 95% of eligible prescription drug expenses for the rest of a calendar year. The copay will then be 5% to the participant.

The Health Fund will also only require a single copay for a “diabetic kit”, which includes insulin and the supplies required to inject it (needles and syringes). This will reduce the out-of-pocket costs to a diabetic.

*The Health Fund has a Mandatory Generic Drug Program, “Generic First”, for prescriptions that treat high Blood Pressure, Cholesterol, and Acid Reflux. Under this program, the Fund will only pay for generic drugs in these classes (unless the medical necessity for a brand name drug has been established by a participant’s physician). For more information regarding this program, visit our website, www.equityleague.org.

The Health Fund now has a Mandatory Mail Order Program for “Maintenance” prescriptions which will be required after the first time a new prescription is written and has been refilled at a local pharmacy. Mail order can be used immediately instead of having to go to a local pharmacy – and this is preferable for prescriptions written on drugs that have been taking for a while. However, for drugs that are newly prescribed to you, or for situations in which a new dose of a drug you have been taking is ordered by your physician, it is recommended that you secure your first 30 day of supply of drugs locally. This helps to assure that the drug is both effective in treating your condition and does not generate serious side effects, before you begin to take that drug on a long term basis. Please visit our website, www.equityleague.org, under the Health Section for additional information.

The CIGNA Member Assistance Program (MAP) is no longer available to participants. The description of this benefit on pages 43, 55, and 75 no longer applies to participants covered for coverage under the Health Plan.

Page 3 – Eligibility and Participation:

How Eligibility is Determined

The current eligibility rules are as follows:

• Four times each year, the Fund looks back over the preceding 12 months (the “accrual period” ) to see if you had enough benefit credits (weeks of covered employment) to qualify for coverage in the next “benefit period.” (A benefit period starts on the same date as a calendar quarter – each January 1, April 1, July 1, and October 1.)

• If you have at least 20 benefit credits during the 12 months preceding the look back, you will be eligible for 12 months of health coverage beginning at the start of the next benefit period.

• If you do not have 20 benefit credits, but do have at least 12 benefit credits in the 12 months preceding the look back, you will be eligible for 6 months of Health Fund coverage beginning at the start of the next benefit period.

• If you don’t have at least 12 benefit credits, you won’t be eligible for Health Fund participation; however, your work history will continue to be examined at each quarterly look back until you are eligible for coverage.

When Participation Begins

There is a three-month gap (known as the “waiting period”) between the date on which your eligibility is determined and the first day of the benefit period in which coverage actually starts. For example, if you qualify for health coverage during the accrual period ending in December, you will be eligible to begin your coverage on April 1.

The following table shows how this rule applies for all accrual and benefit periods:

ACCRUAL PERIOD 12 MONTHS COUNTING FROM:	WAITING PERIOD	BENEFIT PERIOD
FIRST SUNDAY IN: TO LAST SUNDAY IN :	3 MONTHS COUNTING FROM:	6 OR 12 MONTHS OF COVERAGE STARTING ON:
October September January December April March July June	October December January March April June July September	January 1 April 1 July 1 October 1

A $100 quarterly contribution is require.

Participants covered by employment (meeting the eligibility requirements) are required to pay a $100.00 quarterly premium in order to receive their health coverage under the Equity-League Health Trust Fund. The Fund Office will mail out an election notice along with a billing invoice each quarter. Participants can also pay the full cost of coverage at one time - $200.00 for 6 months of health coverage, and $400.00 for 12 months of health coverage. One of the advantages of the $100.00 quarterly premium is the chance to delay your Health Fund coverage start date. This can come in handy when you have at least 12 but fewer than 20 benefit credits in an Accrual Period and want to save them for the next Accrual Period (which you may want to do if you expect to earn enough credits to bring your total up to 20). You can save them until you have enough for 12 months of coverage, if you like. (But don’t hold on to them too long; remember, benefit credits expire after a year.)

Payment Due Dates for the $100.00 Quarterly Contribution:

The table below shows the premium contribution schedule - please note the premium due dates as they are critical to assuring that you do not lose coverage.
The "Due Date" (shown in Column Two) is one month before coverage begins to assure that coverage is in place in our records well before the start (or continuation) of that coverage. The "Last Date to Assure Timely Coverage" means that if we receive your payment by that date, we will assure that CIGNA's records will reflect coverage accurately when you present your identification (ID) card at the doctor's office, pharmacy or hospital. If your payment is received after that date, we cannot assure that your ID card will not be rejected by a provider as of the first day coverage begins (e.g. if you pay after December 15 and present your card to your physician on January 1. the doctor may well say that you have no coverage). This will eventually be rectified, but you may well be turned away from treatment until the records are corrected.

The “Last Date for Penalty Avoidance” is the last date that payment can be received without your incurring a late penalty. A payment made at this late date will still mean that your coverage will not be reflected in CIGNA’s records when you present your ID card to a provider (CIGNA’s records will not be accurate until about two weeks after we received payment), but coverage for the full benefit period will ultimately be secured.

Finally, the “Last Date that Coverage Can Be Activated With a Major Penalty” is the last date on which you can secure coverage at all, but with two penalties. First, you will be required to pay an extra $100. In addition, your coverage will not begin until the day payment is received, so if you pay after the quarter begins, you will lose some coverage you otherwise would have received. In addition, it will still take about two weeks for coverage to be reflected in CIGNA’s records, though it will be backdated to the date that payment was received. Any payment received more than 31 days after the coverage period begins will not be accepted under any circumstances. Your opportunity for coverage will be irrevocably lost. You will not be offered coverage again unless your work weeks earn you eligibility once again.

For more information, and examples of how the rules described above work, log on to our website, www.equityleague.org and click on Current Health Fund Eligibility Rules. If you don’t have a computer, you can request a copy of that information from the Fund Office.

QUARTER BEGINNING ON	DUE DATES FOR YOUR CONTRIBUTION	LAST DATE TO ASSURETIMELY COVERAGE	LAST DATE FOR PENALTY AVOIDANCE	LAST DATE FOR COVERAGE TO BE ACTIVATED WITH A  MAJOR PENALTY
January 1	December 1 of the preceding year	December 15 of the preceding year	December 31 of the preceding year	January 31
April 1	March 1	March 15	March 31	April 30
July 1	June 1	June 15	June 30	July 31
October 1	September 1	September 15	September 30	October 31

*Very important note: All of the above due dates are for actual receipt of payment. It does not matter when your payment was mailed or otherwise transmitted to the Fund Office, it must be received by the Fund Office by the due dates shown. We recommend that you check your bank statements, credit card bills and similar records to assure that we have actually received your payment (or you can contact the Fund Office to check whether your payment has been received).

If you make other payments to the Fund (such as those required for dependent coverage – see pages 4-6- or for self-pay dental coverage – see pages 46-49 of the Health SPD), they will all be due at the same time, and therefore the deadline would apply to these amounts as well. If circumstances prevent you from getting your payment in by the first of the month, we can accept payments up to the last day of the month prior to the start of a quarter (in other words, there is a one-month grace period). Please note that we cannot guarantee coverage as of the first of the month if a payment is received after the 15th of the month. There is a very good chance your coverage won’t be recognized on time if you don’t get your payment in by the 15th.

An Example of When Benefits Begin. Anne earns 12 benefit credits by the end of December, 2008 (that is, she worked 12 weeks in covered employment from the first Sunday in January, 2008 through the last Sunday in December, 2008). In mid-January she receives an election notice from the Fund Office that tells her that she can choose to “spend” her credits on 6 months of coverage starting April 1, 2009. The notice also informs her that if she wants to do this, she must return her billing invoice, along with a $100.00 payment, to the Fund Office no later than March 1. Anne, however, knows that she has work lined up for the next few months—enough to earn 10 more credits. She decides to wait.

In mid-April, the Fund Office sends her another election notice. This one shows that she now has 20 benefit credits (because she worked 20 weeks in covered employment from the first Sunday in April, 2008 through the last Sunday in March, 2009). She can choose to spend all of them on 12 months of coverage starting July 1, 2009, or spend none of them. Anne elects the first option (12 months of coverage) and returns her billing invoice, along with a $100.00 payment, to the Fund Office by June 1. She keeps her coverage in effect throughout the 12 month period by paying the invoice the Fund Office sends her prior to the start of each of the next three calendar quarters.

For more information, and examples of how the current eligibility rules apply, please visit our website, www.equityleague.org, and click on the Health Section from our site’s homepage. If you do not have a computer, you can request a copy of this information from the Health Department within the Fund Office.

Page 4:

Reinstatement of Coverage:

The reinstatement of health coverage provision is still in effect. We have provided you with a current example of how you can reinstate your eligibility for coverage under the Equity-League Health Trust Fund:

Suppose you have not earned 12 benefit credits between Sunday, October 7, 2007 and Sunday, September 28, 2008. Your benefit coverage ends on December 31, 2008. The next look back date is through Sunday, December 28, 2008, and applies to the Accrual Period of Sunday, January 6, 2008 to Sunday, December 28, 2008. If you have earned at least 12 benefit credits during this period, your benefits will be reinstated on April 1, 2009, in the event that the $100.00 quarterly contribution is paid.

Open Enrollment:

Effective January 1, 2009, the annual “Open Enrollment” period to change your health coverage (medical and vision), and/or add dependents, switched from May of each year, with an effective date of July 1, to November of each year, with an effective date of January 1. This update also applies to the Electing an HMO section on page 40 of the SPD.

Page 9:

Ongoing Premium Payments for Self-Pay Health Coverage:

Effective January 1, 2008, the Health Fund applied the following deadlines and grace periods to contribution payments for those that self-pay for health coverage:

Your health fund contributions are due on the first day of the quarter. For example, for self-pay coverage that starts on April 1, 2009, your premium payment is due to the Fund Office by April 1, 2009. This rule also applies to all participants whose only coverage is self-pay coverage (Dental only, COBRA, Vested Beyond COBRA, or Supplemental Medicare coverage – these coverages have remained unchanged, and are explained within the SPD). If circumstances prevent you from getting your payment in to us by the first day of the quarter, from this point forward, we can accept payments only up to the last day of the month after the quarter begins (in other words, there’s a one-month grace period – April 30, 2009). However, please note that if you don’t make your payments until after the quarter begins, eligibility will be applied retroactively, which can lead to trouble with any expenses you incur before you are listed on the eligibility files.

Page 10:

Converting to an Individual Medical Policy:

Please be aware that the Fund no longer allows participants or dependents to convert to an individual policy with CIGNA once your group coverage through the Health Fund ends. This provision became effective April 1, 2006, when the Health Fund changed from a Full Insured Health Plan to a Self-Insured Health Plan. Individual Medical Policies are not permissible under a Self-Insured Medical Plan.

If you Become Disabled:

Effective July 1, 2009, this benefit provision no longer applies under the Health Fund. If you were totally when Health Fund coverage ends, charges relating to the illness or injury that caused the disability will no longer continue to be covered by CIGNA for up to one year.

Page 15:

CIGNA Medical Plan Benefit Chart

Preventive Care (including immunizations)

• Well-child care (including immunizations) is covered for children through age 19.
  
• Effective October 1, 2009, New York residents are now charged a $25.00 co-payment for In-Network services.

Page 17:

CIGNA Medical Plan Benefits:

Effective July 1, 2006, an emergency room copay of $50.00 within a hospital, whether you go In-Network, or Out-of-Network, became required under the CIGNA Medical Plan. Please note that this charge will be waived if you are admitted to the hospital within 24 hours of your emergency room visit. This update also applies to the Emergency and Urgent Care section on page 25 of the SPD.

Page 18:

CIGNA Medical Plan Benefits:

Effective January 1, 2010, the Health Fund will implement a change where the co-payments for In-Network Chiropractic and Physical Therapy providers will be reduced from $25 to $15. Also, a $4,000.00 annual cap between in and out-of-network visits will be placed on certain Chiropractic and Physical Therapy treatments in order to limit costs under the Plan. Please visit our website, www.equityleague.org, under the Health Section for additional information. This update also applies to the Chiropractic Care on page 26 of the SPD.

Page 20:

CIGNA Medical Plan Benefits:

Under Mental Health Services, the Health Fund added Intensive Outpatient Mental Health programs, in which a maximum of 3 per calendar year are allowable based on a ratio of 1:1 inclusive of the 45 outpatient Mental Health visit limitation. This update also applies to the Mental Health Services section on page 29 of the SPD.

Page 21:

CIGNA Medical Plan Benefits:

Under Alcohol and Drug Abuse, the Health Fund added Intensive Outpatient Substance Abuse programs, in which a maximum of 3 per calendar year are allowable based on a ratio of 1:1 inclusive of the 60 outpatient Substance Abuse visit limitation. This update also applies to the Substance Abuse Services section on page 30 of the SPD.

Pages 44 and 45:

Vision Care:

Effective October 1, 2009, the Health Fund implemented an improvement under the Davis Vision Plan where eye exams will be covered on an annual basis instead of every two years. In addition, the in-network credit for non Davis Vision frames will be increased from $30 to $100 in addition to a 20% discount for any amount in excess of $100. Also, the in-network allowance for contact lenses that are not in the Davis Vision formulary will be increased from $75 to $115 with a 15% discount for any amount over $115. The co-pay for formulary contact lenses will change from $25 for existing wears and $45 for new wearers to $25 for all wearers. Please visit our website, www.equityleague.org, under the Health Section for additional information.

Page 46:

Enrolling for Self-Pay Dental Coverage:

The annual open enrollment period for dental coverage is now the same as the open enrollment period for medical and vision coverage; November of each year, in which the coverage will be in effect the first of the following year, January 1.

Page 55 – Submitting Claims:

Self-Pay Dental Benefits:

If you receive services from a provider who is not in the CIGNA PPO network, you must submit a claim for reimbursement to:

CIGNA Dental.
P.O. Box 188037
Chattanooga, TN 37422-8037

This address also pertains to any questions you may have regarding dental coverage, and also replaces the address on page 75 for contacting CIGNA Dental. They can also be reached at 1-800-244-6224.

Vision Plan Benefits:

If you receive services from a provider who is not in the Davis Vision network, you must submit a claim for reimbursement to:

Davis Vision, Inc.
Vision Care Processing Unit
P.O. Box 1525
Latham, NY 12110

This address also pertains to any questions you may have for Davis Vision, and also replaces the address on page 75 for contacting Davis Vision. They can also be reached at 1-800-999-5431.

Supplemental Workers Compensation.

The period for filing Supplemental Workers Compensation claims increased to 12 months from the date of your Workers’ Compensation award. As a reminder, you can get a claim form for a Supplemental Workers’ Compensation benefit through the Fund Office or from any Actors’ Equity office. You must complete the form in its entirety and attach a statement from your physician.

Sincerely yours,

Equity-League Health Trust Fund

Health Summary Plan Description

  Health Summary Plan Description (PDF, 649K) healthspd.pdf 82 Pages

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A summary guide to health benefits available through the Health Fund.

Most of the rules and benefit descriptions within the SPD still apply to the Health Fund. We have provided you with a current update on some of the changes that have become effective after April 1, 2005, the date the Health SPD was first completed.

If you have any questions, please contact the Health Department and a representative will assist you.